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Literature review highlights options for self-management of asthma exacerbations

An extensive literature review undertaken by the Woolcock Institute of Medical Research has examined the pharmacological strategies for self-management of asthma exacerbations in adults, including those using inhaled corticosteroid/long-acting 2-agonist (ICS/LABA) therapy.

The review provides evidence-based recommendations on the best way to use oral corticosteroids (OCS) to treat severe exacerbations and questions whether studies support the common practice of doubling inhaled corticosteroids (ICS) doses as a form of treatment. It also looks at whether increasing ICS to high doses is an alternative to OCS, as well as the effects of increasing the dose of combination therapy during exacerbations.

Use of inhaled ICS/LABA for maintenance and relief, and the effectiveness of short- acting 2-agonist (SABAs) in the management of exacerbations have also been addressed.

Dr Helen Reddel of the Woolcock Institute and Dr David Barnes from Royal Prince Alfred Hospital, authors of the narrative review which is published in the latest issue of European Respiratory Journal, said the project was undertaken in a bid to help clinicians determine the specific therapeutic instructions which should be included in written asthma action plans.

Dr Reddel explains most of the advice in current international guidelines about how to manage exacerbations was published prior to the introduction of combination therapy.

"However recent years have seen an increase in the proportion of patients being prescribed combination inhaled corticosteroid/long-acting 2-agonist therapy in one inhaler device for the management of persistent asthma," she said.

"The review recognises the importance of written action plans as a beneficial part of an integrated program to substantially improve health outcomes for people with asthma. Our aim was to determine what recommendations should be included in these plans and to make sure they encompas
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Contact: Lucy Williams
61-403-753-028
Research Australia
3-Jul-2006


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